Pediatric emergency medicine trisk 3350 3350
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (100.53 KB, 1 trang )
FIGURE 109.8 Operative exploration of a Jersey finger injury, demonstrating the ruptured
flexor digitorum profundus tendon. (Courtesy of Children’s Orthopaedic Surgery Foundation.)
Proximal phalanx injuries are some of the most common pediatric hand injuries
and are managed similarly to middle phalangeal injuries. The base of the
proximal phalanx often endures a Salter–Harris II fracture (see Fig. 111.2 for
Salter-Harris Classification system), with the small (i.e., the fifth) finger being the
most frequently affected. Many are managed with splinting/casting following
closed reduction when necessary. Reduction can be an emergency room
procedure in appropriately trained hands using the “pen-in-the-web-space”
technique. Nondisplaced shaft fractures are generally managed with
immobilization. Displaced and angulated fractures may require surgical
stabilization. Phalangeal neck fractures can be difficult to diagnose. Oblique view
radiographs may be of assistance ( Fig. 109.10 ). These fractures require very
close outpatient care, as displacement and rotation may have long-term
consequences on the flexion of the adjacent IP joint. Finally, intra-articular
condyle fractures may involve one or both condyles and long-term management
may depend on the degree of displacement and severity of the injury ( Fig. 109.11
). Close follow-up is required in these injuries; many require surgical
stabilization. It is important to note that a finger splint does not provide adequate
support for a proximal phalanx fracture. A hand- or forearm-based splint is
necessary.
